A Review on Fat Necrosis of the Breast: The Dilemma of Differential Diagnosis with Cancer

Fat necrosis is a benign inflammatory process which can involve adipose tissue anywhere in the body. A previous history of trauma or surgery may or may not be present. Information about the clinical and radiological appearance of this lesion is very important because it can mimic breast cancer. In this article, we review the features of fat necrosis in different imaging modalities including mammography, ultrasound, and magnetic resonance imaging (MRI), and compare them with histopathologic findings; then, we try to provide a logical approach for fat necrosis management. The appearance of fat necrosis at imaging is variable from definitely benign type to highly suspicious for malignancy. The specificity of mammography is higher than that of ultrasonography; therefore, for a definite diagnosis of fat necrosis, emphasis should be mainly based on mammography rather than ultrasonography. Finally, fat necrosis is not a common disease; however, regarding unusual and atypical findings in different imaging modalities, differentiation from a cancer may be difficult, especially in patients with a previous history of malignancy. Therefore, a multimodality approach is required for a definite diagnosis

Five-year Study of Patients with Lactating Adenoma and Review of the Literature

Background: Lactating adenoma is a benign breast mass related to physiological changes during pregnancy and increased estrogen level. Fibroadenoma and breast cancer should be considered in the differential diagnosis of this lesion. The purpose of this study was to report cases of lactating adenoma in Breast Cancer Research Center (BCRC) and review the relevant literature. Methods: All patients with histological diagnosis of lactating adenoma between April 2010 and December 2015 were selected. Patients’ data were extracted from their medical records and follow-up of the patients were done through in-person examination or rarely by telephone call. Results: A total of 22 patients with pathological diagnosis of lactating adenoma were enrolled. The mean age of patients was 27±4.6 years. Fourteen patients were in breast-feeding period and eight were pregnant at the time of diagnosis. The chief complaint was breast mass in 16 patients and pain 6 patients. The mean size of masses was 4.1 cm (1.8-8 cm). For 13 patients, core needle biopsy (CNB) and for 6 patients open biopsy were performed and for the other 3 patients vacuum-assisted biopsy were done. In 5 patients, excisional biopsy was done in the follow-up period that one of them proved to be medullary carcinoma and other cases were benign. Conclusions: Lactating adenoma commonly presents as a palpable mass during the breastfeeding period or the third trimester of pregnancy. The most common ultrasonographic appearance is a hypoechoic mass with regular borders. It usually regresses after cessation of breastfeeding, however in patients with mass enlargement during the follow-up, period pathologic evaluation of the lesion through core needle biopsy should be performed to rule out coexistent carcinoma

Ultrasound features of pregnancy‐associated breast cancer: A retrospective observational analysis

Abstract Pregnancy‐associated breast cancer (PABC) is a poor prognosis in women, and the mortality rate is higher in this subgroup of patients than in non‐PABC. This study aims to assess clinicopathological and ultrasound features of patients with PABC. Of 75 patients with breast cancer, 31 cases were in lactating, or pregnancy phase and 44 patients had no recent history of pregnancy/lactation at the time of cancer detection. The available pathological characteristics and ultrasound findings of the PABC and non‐PABC groups were compared. The analysis of ultrasound findings demonstrated that the percentages of antiparallel orientation (p = 0.04) and heterogeneous internal echo pattern (p = 0.002) were higher in the PABC group. The final Breast Imaging Reporting and Data System (BI‐RADS) assessment in the two groups was significantly different (p = 0.008). In this study, most PABCs were BI‐RADS 4c or 5; compared with age‐matched non‐PABC cases. There were significant differences in ER (p = 0.03), receptor groups (p = 0.007), and tumor grade (p = 0.02) in PABC compared to non‐PABC group. To conclude, radiologists should be careful about ultrasound findings of PABC and recommend core needle biopsy in suspected cases

Comparison of Clinicopathological Characteristics and Outcome of Inflammatory and Non-inflammatory Locally Advanced Breast Cancer: A Study in Iran

Background: Inflammatory breast cancer (IBC), a subgroup of locally advanced breast cancer (LABC), is diagnosed based on clinical findings, and seems to be different from other types of LABC. The purpose of this study was to compare clinicopathological characteristics and outcomes between inflammatory and non-inflammatory LABC patients at Breast Cancer Research Center (BCRC), Tehran, Iran. Methods: The medical records of all patients who were diagnosed as LABC in BCRC  since  1997  to  2011  were  extracted  from  the database. Then,  clinical  and pathological characteristics and overall survival of IBC patients were compared with non-inflammatory LABC (NI-LABC). Results: A total number of 340 patients were identified as LABC from which 17 patients (5%) were diagnosed as IBC. Menopausal status, body mass index (BMI), family history of breast cancer, nodal status, and Her2/neu and PR positivity were not statistically different between IBC and NI-LABC groups. The difference in estrogen receptor (ER) between the two groups was significant (P = 0.028). Median duration of follow-up was 26.50 months. Patients with IBC had overall survival of 27.9 months (95% CI: 22.7–33.1) which was lower than patients in the NI-LABC group with a survival of 118.9 months (95% CI: 107.3–130.6) (P = 0.015). The difference between the disease-free survivals of the two groups were also statistically significant (P < 0.001). Conclusions: Compared to NI-LABC, IBC is more frequently ER negative and more commonly associated with lower survival rate. These findings reinforce the idea that IBC has a more aggressive biology and more unfavorable outcome than NI-LABC and needs close follow-up

Sexual Dysfunction in Breast Cancer: A Case-Control Study

Background: Sexual dysfunction in breast cancer patients is considered as a common and distressing problem. Considering the increasing number of breast cancer survivors living for longer periods of time with the disease and the importance of their quality of life, we conducted the present study to compare the sexual functioning in breast cancer patients with their healthy counterparts. Methods: In this case-control study, breast cancer patients who completed their treatment protocol and were followed up for at least six months were included. The controls were healthy women with normal clinical breast examinations. All subjects filled-in the Persian version of Female Sexual Function Index questionnaire. Results: A total of 165 subjects including 71 breast cancer patients and 94 healthy women were studied. The frequency of sexual dysfunction in cases and controls was 52.6% and 47.4%, respectively (P = 0.09). There were no significant differences between the two groups regarding domain scores, except for vaginal lubrication (P = 0.045). Logistic regression analysis indicated that significant determinants of sexual dysfunction in breast cancer group was patients' age (OR = 4.0, 95%CI: 1.3 – 11.5, P = 0.01) and age of the spouse (OR= 9.8, 95% CI: 1.8-51.9, P= 0.007), while in controls, only emotional relationship with the husband was the significant predictive factor (OR = 6.3, 95%CI: 1.9 – 20.5, P = 0.002). Conclusions: Our findings indicated that sexual dysfunction is prevalent in Iranian women regardless of their physical health status. The frequency of vaginal dryness in breast cancer patients was significantly higher than controls. Age of the patient and the spouse (>40) were the only significant predictors of sexual dysfunction among women with breast cancer. Preventive strategies, sexual education and access to effective treatment should be planned in supportive care of breast cancer patients

Predictive Role of EGFR, IGF-1R, VEGFR2 and HIF-1? Expression on Survival of Patients with Triple-negative Breast Cancer

Background: Triple-negative breast cancer (TNBC) carries a poor prognosis and therapeutic options are limited to date. The aim of this study was to investigate to what extent the epidermal growth factor receptor (EGFR), vascular endothelial growth factor receptor 2 (VEGFR2), hypoxia inducible factor-1 alpha (HIF-1?) and insulin-like growth factor-1 receptor (IGF-1R) are expressed in TNBC and to determine if these expressions have a predictive role. Methods: Of 923 breast cancer patients who were treated and followed in Academic Center for Education, Culture and Research (ACECR) from 2006-2010, 104 of them had TNBC. Immunohistochemistry analyses were performed on tissue microarray blocks with antibodies for EGFR, VEGFR2, HIF-1? and IGF-1R. Results: We analyzed tumor samples from 104 patients with classic primary invasive ductal carcinoma (IDC). Fifteen patients (14%) were in stage I, 46.6% in stage II, 30.1% in stage III and 5.8% in a metastatic stage (stage IV). The median overall survival (OS) was 48 months. EGFR was expressed in 15 (14%), VEGFR2 in 63 (61%), IGF-1R in 81 (78%) and HIF-1? in 57 (55%) samples. EGFR expression was significantly associated with poor outcome in terms of OS (P = 0.021, OR = 3.9). Conclusions: Among the four investigated tumor markers, only EGFR was significantly associated with survival of patients with TNBC

Cancer Is Associated with the Emergence of Placenta-Reactive Autoantibodies

Placenta-specific antigens are minimally expressed or unexpressed in normal adult tissues, while they are widely expressed in cancer. In the course of carcinogenesis, a vast array of autoantibodies (AAbs) is produced. Here, we used a quantitative approach to determine the reactivity of AAbs in the sera of patients with breast (BrC: N = 100, 100% female, median age: 51 years), gastric (GC: N = 30, 46.6% female, median age: 57 years), bladder (BC: N = 29, 34.4% female, median age: 57 years), and colorectal (CRC: N = 34, 41.1% female, median age: 51 years) cancers against first-trimester (FTP) and full-term placental proteome (TP) in comparison with age- and sex-matched non-cancer individuals. Human-on-human immunohistochemistry was used to determine reactive target cells in FTP. The effect of pregnancy on the emergence of placenta-reactive autoantibodies was tested using sera from pregnant women at different trimesters of pregnancy. Except for BC, patients with BrC (p p p p p < 0.0409) in the early stages triggered higher autoantibody reactivity against FTP. The reactivities of BrC sera with FTP did not show an association with ER, PR, or HER2 expression. Pregnancy in the third trimester was associated with the induction of TP- and not FTP-reactive autoantibodies (=0.018). The reactivity of BrC sera with placental proteins was found to be independent of gravidity or abortion. BrC sera showed a very strong and specific pattern of reactivity with scattered cells beneath the syncytiotrophoblast layer. Our results reinforce the concept of the coevolution of placentation and cancer and shed light on the future clinical application of the placental proteome for the non-invasive early detection and treatment of cancer

A micropillar array-based microfluidic chip for label-free separation of circulating tumor cells: The best micropillar geometry?

Introduction: The information derived from the number and characteristics of circulating tumor cells (CTCs), is crucial to ensure appropriate cancer treatment monitoring. Currently, diverse microfluidic platforms have been developed for isolating CTCs from blood, but it remains a challenge to develop a low-cost, practical, and efficient strategy. Objectives: This study aimed to isolate CTCs from the blood of cancer patients via introducing a new and efficient micropillar array-based microfluidic chip (MPA-Chip), as well as providing prognostic information and monitoring the treatment efficacy in cancer patients. Methods: We fabricated a microfluidic chip (MPA-Chip) containing arrays of micropillars with different geometries (lozenge, rectangle, circle, and triangle). We conducted numerical simulations to compare velocity and pressure profiles inside the micropillar arrays. Also, we experimentally evaluated the capture efficiency and purity of the geometries using breast and prostate cancer cell lines as well as a blood sample. Moreover, the device’s performance was validated on 12 patients with breast cancer (BC) in different states. Results: The lozenge geometry was selected as the most effective and optimized micropillar design for CTCs isolation, providing high capture efficiency (>85 %), purity (>90 %), and viability (97 %). Furthermore, the lozenge MPA-chip was successfully validated by the detection of CTCs from 12 breast cancer (BC) patients, with non-metastatic (median number of 6 CTCs) and metastatic (median number of 25 CTCs) diseases, showing different prognoses. Also, increasing the chemotherapy period resulted in a decrease in the number of captured CTCs from 23 to 7 for the metastatic patient. The MPA-Chip size was only 0.25 cm2 and the throughput of a single chip was 0.5 ml/h, which can be increased by multiple MPA-Chips in parallel. Conclusion: The lozenge MPA-Chip presented a novel micropillar geometry for on-chip CTC isolation, detection, and staining, and in the future, the possibilities can be extended to the culture of the CTCs